1770515983 NPI number — DR. JILL R WHITE MD

Table of content: DR. JILL R WHITE MD (NPI 1770515983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770515983 NPI number — DR. JILL R WHITE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
JILL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RYDQUIST
Provider Other First Name:
JILL
Provider Other Middle Name:
ERIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770515983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3824 NORTHERN PIKE
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-2141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-457-0060
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 RODI RD
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15235-3318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-371-6414
Provider Business Practice Location Address Fax Number:
412-371-9739
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD064480L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001683314 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103041 . This is a "VPMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 370010592 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5257636 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 678052 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: P001106 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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